title: Proton radiotherapy for parameningeal rhabdomyosarcoma: clinical outcomes and late effects.
abstract: OBJECTIVE
  To report the clinical outcome and late side effect profile of proton radiotherapy in the treatment of children with parameningeal rhabdomyosarcoma (PM-RMS).
  
  
  METHODS
  Seventeen consecutive children with PM-RMS were treated with proton radiotherapy at Massachusetts General Hospital between 1996 and 2005. We reviewed the medical records of all patients and asked referring physicians to report specific side effects of interest.
  
  
  RESULTS
  Median patient age at diagnosis was 3.4 years (range, 0.4-17.6). Embryonal (n = 11), alveolar (n = 4), and undifferentiated (n = 2) histologies were represented. Ten patients (59%) had intracranial extension. Median prescribed dose was 50.4 cobalt gray equivalents (GyRBE) (range, 50.4-56.0 GyRBE) delivered in 1.8-2.0-GyRBE daily fractions. Median follow-up was 5.0 years for survivors. The 5-year failure-free survival estimate was 59% (95% confidence interval, 33-79%), and overall survival estimate was 64% (95% confidence interval, 37-82%). Among the 7 patients who failed, sites of first recurrence were local only (n = 2), regional only (n = 2), distant only (n = 2), and local and distant (n = 1). Late effects related to proton radiotherapy in the 10 recurrence-free patients (median follow-up, 5 years) include failure to maintain height velocity (n = 3), endocrinopathies (n = 2), mild facial hypoplasia (n = 7), failure of permanent tooth eruption (n = 3), dental caries (n = 5), and chronic nasal/sinus congestion (n = 2).
  
  
  CONCLUSIONS
  Proton radiotherapy for patients with PM-RMS yields tumor control and survival comparable to that in historical controls with similar poor prognostic factors. Furthermore, rates of late effects from proton radiotherapy compare favorably to published reports of photon-treated cohorts.
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Childs
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Kozak
authors.forename: Alison M
authors.initials: AM
authors.lastname: Friedmann
authors.forename: Beow Y
authors.initials: BY
authors.lastname: Yeap
authors.forename: Judith
authors.initials: J
authors.lastname: Adams
authors.forename: Shannon M
authors.initials: SM
authors.lastname: MacDonald
authors.forename: Norbert J
authors.initials: NJ
authors.lastname: Liebsch
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Tarbell
authors.forename: Torunn I
authors.initials: TI
authors.lastname: Yock
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008404:Massachusetts; D008577:Meningeal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D059351:Organ Sparing Treatments / Q000379:methods; D061766:Proton Therapy; D011522:Protons / Q000009:adverse effects; D011878:Radiotherapy / Q000009:adverse effects; D012208:Rhabdomyosarcoma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D018232:Rhabdomyosarcoma, Alveolar / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D018233:Rhabdomyosarcoma, Embryonal / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D016896:Treatment Outcome
chemical_list: D011522:Protons